Hemorrhoid

HemorrhoidTraditional surgical approaches (hemorrhoidectomy)

Several approaches of hemorrhoidectomies are known. They are named after their respective inventors. Traditional surgical approaches demonstrate a low recurrence rate.

Milligan-Morgan (open hemorrhoidectomy): Three hemorrhoidal knots are extracted through the anus using clamps. After detachment of the hemorrhoidal tissue from the sphincter, the hemorrhoids are removed using a scalpel. The wounds are left open (this is why it is called 'open' hemorrhoidectomy).

Ferguson (closed hemorrhoidectomy): This approach is an extension of the Milligan-Morgan method. Here, the hemorrhoid is closed using a continuous, longitudinal suture down to the anoderm.

Parks (submucosal hemorrhoidectomy): A Y-cut is used to expose the subhemorrhoidal cushion. The supplying blood vessels are tied. After removal of the hemorroid, the margins of the wound are sutured in a T conformation.

Fansler-Arnold (reconstructive hemorrhoidectomy): Anal skin is moved to the outside, then incised interiorly. The underlying hemorrhoid is removed. The skin flap is then sutured to the internal anus.

Whitehead (supraanodermal hemorrhoidectomy): The hemorrhoidal cushion is excised in a circular fashion. The anal skin of the anoderm is usually completely destroyed in the process.

New surgical approaches
Newer surgical approaches tend to be less invasive compared to traditional methods.

Longo's stapled hemorrhoidopexy: This procedure is prepared by dilation of the anal canal and placement of a circular suture in the rectum, superior to the dentate line. A stapler is then used to remove excess tissue, at the same time placing two rows of staples that secure the remaining hemorrhoidal cushions. The lesion is closed with another suture.

Doppler-guided hemorrhoid artery ligation (HAL): This approach consists of a hemorrhoidal dearterialization above the dentate line. First, the arteries' exact locations are determined using ultrasound and a specifically designed proctoscope. Then the arteries are tied off using a wire. This procedure can be performed on an outpatient basis.

Transanal hemorrhoidal artery ligation (THD): This method is an advancement of the HAL approach. In addition to dearterialization, a lifting of the protruded mucosal and hemorrhoidal tissue is performed.

Minimally-invasive, subanodermal, submucosal hemorrhoidoplasty (MISSH): In addition to dearterialization, the hemorrhoid is mobilised into the pain-free area above the dentate line (anal lifting).